The need to make a personal additional payment (the 'gap') arises because, the Federal Government, through its Medicare legislation, controls the size of the rebate you are allowed to receive from Medicare & your private fund. The result is that your anaesthetic fee will be fully covered on only rare occasions. In fact, sometimes the amount the Government allows to be rebated to you may be only one third to one half of the actual fee.
Regardless of which hospital you attend, the size of the shortfall or "gap", for which the government prevents you being covered, is usually between $150 and $600. For some procedures which require unusually long or complicated anaesthesia the shortfall may be greater than this.
The reasons for this 'gap' are many and complex but mostly relate to the effects of inflation since 1972 (when the rebates did cover full fees charged), the relative value of anaesthesia services, and the government reductions in your Medicare benefits relative to inflation since then.
The term "schedule fee" is the name used by the government to refer to the maximum benefit, or rebate, it allows you to receive. It is determined unilaterally by the government and is not an arbitrated or "agreed" fee as some people believe.
If you feel you may have difficulties with the shortfall, or you would like more information about the "gap" for your own anaesthetic, you should discuss the matter with your anaesthetist prior to your operation.
Anaesthetists as a group are most concerned about the unfair and inadequate rebates the government has allowed you for anaesthetic services and will do their best to assist you.
For more information please refer to www.allaboutanaesthesia.com.au
